Aspirin in the Prevention of Colorectal Neoplasia

High-quality evidence indicates that regular use of aspirin is effective in reducing the risk for precancerous colorectal neoplasia and colorectal cancer (CRC). This has led to US and international guidelines recommending aspirin for the primary prevention of CRC in specific populations. In this review, we summarize key questions that require addressing prior to broader adoption of aspirin-based chemoprevention, review recent evidence related to the benefits and harms of aspirin use among specific populations, and offer a rationale for precision prevention approaches. We specifically consider the mechanistic implications of evidence showing differences in aspirin's effects according to age, the potential role of modifiable mechanistic biomarkers for personalizing prevention, and emerging evidence that the gut micro-biota may offer novel aspirin-associated preventive targets to reduce high-risk neoplasia.

Automated summary

High-quality evidence supports the use of aspirin for primary prevention of colorectal cancer. Key considerations include age-related effects, personalized prevention strategies, and the potential role of gut microbiota in aspirin-associated preventive measures against high-risk neoplasia.